Colonization Rate of Methicillin-resistant Staphylococcus aureus in Neonates: A Single Center Experience

Soo Young Choi; Sang Woo Han; Hye Sun Yoon; Moran Ki

doi:10.14776/kjpid.2012.19.3.111

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Choi, Han, Yoon, and Ki: Colonization Rate of Methicillin-resistant Staphylococcus aureus in Neonates: A Single Center Experience

Original Article

Korean Journal of Pediatric Infectious Diseases

Korean Journal of Pediatric Infectious Diseases 2012; 19(3): 111-120.

Published online: 31 December 2012

DOI: https://doi.org/10.14776/kjpid.2012.19.3.111

Colonization Rate of Methicillin-resistant Staphylococcus aureus in Neonates: A Single Center Experience

Soo Young Choi, M.D., Sang Woo Han, M.D., Hye Sun Yoon, M.D., Moran Ki, M.D.^*

Department of Pediatrics, Eulji University, Seoul Eulji Hospital, Seoul, Korea.

^*Department of Preventive Medicine, Eulji University, Daejeon, Korea.

Corresponding author (yhs3211@eulji.ac.kr)

Received 15 September 2012 Revised 24 October 2012 Accepted 24 October 2012

Abstract

Purpose

The aim of this study is to investigate the colonization rate of Methicillin-resistant Staphylococcus aureus (MRSA) in neonates by different clinical characteristics, to presume the origin of MRSA acquisition, and to identify the risk factors associated with MRSA colonization.

Methods

We retrospectively reviewed the medical records of 1,733 neonates admitted to Seoul Eulji hospital Neonatal Intensive Care Unit between January 2008 and December 2011. Nasal, inguinal and rectal swab specimens were obtained upon admission and each week until discharge. We classified the route of MRSA acquisition as; hospital associated (HA-MRSA) and community associated (CA-MRSA) according to the case definition.

Results

Among 1,733 neonates, 415 (23.9%) were colonized with MRSA. Gestational age, birth weight, delivery type, maternal antibiotics usage before delivery, birth place and care place before admission were influencing factors in colonization of MRSA. The colonization rate was significantly high in neonates without maternal prophylactic antibiotics use before delivery than in the other group (relative risk 2.77, 95% CI 1.88-4.07; P<0.01), and outborns showed higher MRSA colonization rate compared to inborns (relative risk 2.28, 95% CI 1.17-4.42; P=0.015).

Conclusion

We identified the neonatal MRSA colonization rate to be 23.9%. We estimated HA-MRSA colonization rate to be 10% (51/511) and CA-MRSA colonization rate to be 36% (309/858). We ascertained that risk factors in MRSA colonization in neonates were prophylactic use of antibiotics in mothers and the birth place.

Keywords: Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus, Colonization, Newborn

Figures and Tables

Fig. 1

Kaplan-Meier estimated cumulative probability of methicillin-resistant Staphylococcus aureus colonization free staus in hospitalized neonates by birth weight group. Neonates less 1,500 g were methicillin-resistant Staphylococcus aureus non-colonizer when they were admitted. But they rapidly became methicillin-resistant Staphylococcus aureus colonizer over time. Most neonates excess 2,500 g tended to be methicillin-resistant Staphylococcus aureus colonizer when they admitted.

Fig. 2

Kaplan-Meier estimated cumulative probability of methicillin-resistant Staphylococcus aureus colonization free status in hospitalized neonates by care place group. Neonates from community had shorter hospitalized days than inborn neonates. Inborn neonates became methicillin-resistant Staphylococcus aureus colonizer over time. Community means home, private facility (Joriwon) or public facility.

Table 1

Methicilin-resistant Staphylococcus aureus Colonization Rates in Neonates according to Clinical Characteristics

Table 2

Methicilin-resistant Staphylococcus aureus Colonization Rates in Neonates by Invasive Procedures

Abbreviations : C-line, central venous catheter; UVC, umbilical venous catheter; UVA, umbilical artery catheter; A-line, arterial line

Table 3

Risk Factors for Methicilin-resistant Staphylococcus aureus Colonization in Neonates Analyzed With Cox Regression Model

Full model included birth weight, birth place, care place, maternal antibiotics, C-line, UVC, UAC, A-line and intubation.

Abbreviations : C-line, central venous catheter; UVC, umbilical venous catheter; UVA, umbilical artery catheter; A-line, arterial line.

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